A Prospective Study Comparing the Surgical Outcomes Between Laparoscopic Surgery for Transverse and Descending Colon Cancer and Laparoscopic Surgery for Other Colon Cancers.

Introduction: Several prospective randomized trials have demonstrated the long-term oncological safety of laparoscopic surgery for colon cancer. However, transverse/descending colon cancers were excluded from prior randomized controlled trials, mainly because of technical difficulties. This study was designed to compare surgical outcomes between laparoscopic surgery for transverse/descending colon cancers and that for other colon cancers, in the absence of randomized trials comparing laparoscopic and open surgery for transverse/descending colon cancer.Methods: In June 2001, we unified our surgical and postoperative management procedures, and a total prospective registry of 405 patients with colon cancer, who initially underwent laparoscopic surgery between June 2001 and March 2008, were reviewed. Surgical outcomes were compared between laparoscopic surgery for transverse/descending colon cancer (TD group, n=83) and laparoscopic surgery for other colon cancers (Other group, n=322). Indications of laparoscopic surgery were limited to patients with Stage I cancer during the early period.Results: The median follow-up was 37 months. There was no perioperative mortality, and an anastomosis was performed in all patients. One patient with transverse colon cancer required conversion to conventional open surgery because of cancer invasion to the duodenum. Preoperative clinical characteristics were similar between the two groups. Regarding operative and postoperative results, mean surgical duration was significantly greater in the TD group (221 vs. 205 minutes, p=0.0152). However, blood loss was similar between the two groups. There were no significant differences in the postoperative course between the two groups except for a slow fluid intake start in the TD group (1.24 vs. 1.05 days, p=0.0263). There were no perioperative mortalities, and complication rates between the two groups were similar (p=0.5258). There was one anastomotic leakage, and two early reoperations in the Other group. None of the patients treated with curative intent developed recurrence of cancer in the TD group.Conclusions: Laparoscopic surgery for transverse/descending cancer can be performed safely without increased morbidity or mortality, and shows short-term benefits comparable to that in patients who underwent laparoscopic surgery for other colon cancers.